Skip to main content
SpringerLink
Log in

Functional knee stability in non-elite handball: balance and jump performance differ based on players’ position

  • SPORTS MEDICINE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite the great evolvement of sports medicine, there is still a lack of consensus among sports physicians regarding the decision of return to sports after knee injury, especially in non-elite sports. Currently, no sport-specific reference data for an objective reliable evaluation of functional knee stability exist. The purpose of this study was to assess objective measures on knee joint stability from an established test battery in non-elite handball. It was assumed that players’ knee stability differs depending on their field position.

Methods

One-hundred and sixty-five non-elite handball players with a mean age of 24.3 ± 5.5 years underwent a test battery including two-legged and one-legged stability tests, two-legged and one-legged counter movement jumps, two-legged plyometric jumps, one-legged speedy jumps, and a quick feed test.

Results

Athletes’ physical performance differs in terms of field position. Significant differences between handball players of different positions were found in regard to two-legged stability (p < 0.036) and one-legged stability in the dominant leg (p < 0.009). Players of different positions differed in ground contact time of the plyometric jumps (p < 0.017), whereas the other functional tests did not show significant differences.

Conclusion

This study is first to report differences in functional knee stability of non-elite handball players on the basis of objective data. Significant differences of functional performance were noted, which were in congruence with position-specific demands. These findings demonstrate the importance of position-specific screening and training to prevent injuries.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ACL:

Anterior cruciate ligament

AGA:

Society for Arthroscopy and Joint Surgery

ANOVA:

One-way analysis of variance

BiA:

Back in action

BMI:

Body mass index

CI:

Confidence interval

cm:

Centimeter

EB:

Emotional balance

Fig.:

Figure

LoA:

Lack of activation

MPC:

Mental performance capability

ms:

Milliseconds

MS:

Muscular stress

NES:

Negative emotional state

OL-CMJ:

One-legged counter movement jumps

OL-ST:

One-legged stability test

OL-SJ:

One-legged speedy jumps

OR:

Overall recovery

OS:

Overall stress

PPC:

Physical performance capability

Pt.:

Point

Pts.:

Points

QF:

Quick feed test

RTS:

Return to sport

s:

Seconds

SD:

Standard deviation

SRSS:

Short version of the sport-specific Acute and Recovery Stress Scale

TL-CMJ:

Two-legged counter movement jumps

TL-PJ:

Two-legged plyometric jumps

TL-ST:

Two-legged stability test

W:

Watt

References

  1. Achenbach L, Krutsch V, Weber J, Nerlich M, Luig P, Loose O et al (2018) Neuromuscular exercises prevent severe knee injury in adolescent team handball players. Knee Surg Sports Traumatol Arthrosc 26:1901–1908

    Article  PubMed  Google Scholar 

  2. Ardern C, Kvist J, Webster K (2016) Psychological aspects of anterior cruciate ligament injuries. Oper Tech Orthop 24:77–83

    Google Scholar 

  3. Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A et al (2016) 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 50:853–864

    Article  PubMed  Google Scholar 

  4. Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606

    Article  PubMed  Google Scholar 

  5. Ashtiani M, Azghani M, Parnianpour M (2018) Initial balance in human standing postures: roles of the joint mechanisms. Proc Inst Mech Eng H 232:1255–1260

    Article  PubMed  Google Scholar 

  6. Barber-Westin SD, Noyes FR (2011) Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 27:1697–1705

    Article  PubMed  Google Scholar 

  7. Chaouachi A, Brughelli M, Levin G, Boudhina NB, Cronin J, Chamari K (2009) Anthropometric, physiological and performance characteristics of elite team-handball players. J Sports Sci 27:151–157

    Article  PubMed  Google Scholar 

  8. Chelly M, Hermassi S, Aouadi R, Shephard R (2014) Effects of 8-week in season plyometric training on upper and lower limb performance of elite adolescent handball players. J Strength Cond Res 28:1401–1410

    Article  PubMed  Google Scholar 

  9. Dumitru D (2010) The importance of a specific warm-up on the performance of the handball goalkeeper. J Phys Educ Sport 28:23–31

    Google Scholar 

  10. Ebert J, Edwards P, Currie J, Smith A, Joss B, Ackland T et al (2018) Comparison of the 'back in action' test battery to standard hop tests and isokinetic knee dynamometry in patients following anterior cruciate ligament reconstruction. Int J Sports Phys Ther 13:389–400

    Article  PubMed  PubMed Central  Google Scholar 

  11. Everhart JS, Best TM, Flanigan DC (2015) Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:752–762

    Article  PubMed  Google Scholar 

  12. Fieseler G, Hermassi S, Hoffmeyer B, Schulze S, Irlenbusch L, Bartels T et al (2017) Differences in anthropometric characteristics in relation to throwing velocity and competitive level in professional male team handball: a tool for talent profiling. J Sports Med Phys Fitness 57:985–992

    Article  PubMed  Google Scholar 

  13. Fleiss J, Levin B, Paik M (2003) Statistical methods for rates and proportions. Wiley, New York

    Book  Google Scholar 

  14. German Olympic Sports Federation D. Inventory Survey of membership 2018. 2018. Accessed 14 Jan 2019

  15. Goodworth A, Chandan A, Chase H, Foster E, Francoeur H, Michaud J et al (2013) Stance width influences frontal plane balance responses to centripetal accelerations. Gait Posture 37:98–102

    Article  PubMed  Google Scholar 

  16. Goodworth A, Mellodge P, Peterka R (2014) Stance width changes how sensory feedback is used for multisegmental balance control. J Neurophysiol 112:525–542

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gorostiaga E, Granados C, Ibanez J, Gonzalez-Badillo J, Izquierdo M (2006) Effects of an entire season on physical fitness changes in elite male handball players. Med Sci Sports Exerc 38:357–566

    Article  PubMed  Google Scholar 

  18. Haugen T, Tønnessen E, Seiler S (2014) Physical and physiological characteristics of male handball players: influence of playing position and competitive level. J Sports Med Phys Fitness 56:19–26

    PubMed  Google Scholar 

  19. Herbst E, Hoser C, Hildebrandt C, Raschner C, Hepperger C, Pointner H et al (2015) Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery. Knee Surg Sports Traumatol Arthrosc 23:1283–1291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hermassi S, Gabbett TJ, Ingebrigtsen J, Tillaar R, Chelly M, Chamari K (2014) Effects of a short-term in-season plyometric training program on repeated-sprint ability, leg power and jump performance of elite handball players. Int J Sports Sci Coach 9:1205–1216

    Article  Google Scholar 

  21. Hewett T, Ford KR, Myer G (2006) Anterior cruciate ligament injuries in female athletes. Part II: a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med 34:490–498

    Article  PubMed  Google Scholar 

  22. Hildebrandt C, Müller L, Zisch B, Huber R, Fink C, Raschner C (2015) Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part I: development of a new test battery. Knee Surg Sports Traumatol Arthrosc 23:1273–1281

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hitzschke B, Wiewelhove T, Raeder C, Ferrauti A, Meyer T, Pfeiffer M et al (2017) Evaluation of psychological measures for the assessment of recovery and stress during a shockm-microcycle in strength and high-intensity interval training. Perform Enhance Health 5:147–157

    Article  Google Scholar 

  24. Karcher C, Buchheit M (2014) On-court demands of elite handball, with special reference to playing positions. Sports Med 44:797–814

    Article  PubMed  Google Scholar 

  25. Kellmann M (2010) Preventing overtraining in athletes in high-intensity sports and stress/recovery monitoring. Scand J Med Sci Sports 20:95–102

    Article  PubMed  Google Scholar 

  26. Kellmann M, Bertollo M, Bosquet L, Brink M, Coutts A, Duffield R et al (2018) Recovery and performance in sport: consensus statement. Int J Sports Physiol Perform 13:240–245

    Article  PubMed  Google Scholar 

  27. Kellmann M, Kölling S, Hitzschke B (2016) The Acute Measure and the Short Scale of Recovery and Stress for Sports: Manual. Sportverlag Strauß, Hellenthal

    Google Scholar 

  28. Krüger K, Pilat C, Ückert K, Frech T, Mooren FC (2014) Physical performance profile of handball players is related to playing position and playing class. J Strength Cond Res 28:117–125

    Article  PubMed  Google Scholar 

  29. Luig P, Bloch H, Burkhardt K, Klein C, Kühn N (2017) VBG sports report 2017—analysis of accident in the two highest leagues of men in germany: basketball, football and handball. VBG, Hamburg

    Google Scholar 

  30. Luig P, Bloch H, Burkhardt K, Klein C, Kühn N (2018) VBG sports report 2018—analysis of accident in the two highest leagues of men in germany: basketball, football and handball. VBG, Hamburg

    Google Scholar 

  31. Luig P, Krutsch W, Nerlich M, Henke T, Klein C, Bloch H et al (2018) Increased injury rates after the restructure of Germany’s national second league of team handball. Knee Surg Sports Traumatol Arthrosc 26:1884–1891

    Article  PubMed  Google Scholar 

  32. Massuça L, Branco B, Miarka B, Fragoso I (2015) Physical fitness attributes of team-handball players are related to playing position and performance level. Asian J Sports Med 6:e24712

    Article  PubMed  PubMed Central  Google Scholar 

  33. McIlroy W, Maki B (1997) Preferred placement of the feet during quiet stance: development of a standardized foot placement for balance testing. Clin Biomech (Bristol, Avon) 12:66–70

    Article  CAS  Google Scholar 

  34. Miller M, Herniman J, Ricard M, Cheatham C, Michael T (2006) The effects of a 6-week plyometric training program on agility. J Sports Sci Med 5:459–465

    PubMed  PubMed Central  Google Scholar 

  35. Moss S, Mcwhannell N, Michalsik L, Twist C (2015) Anthropometric and physical performance characteristics of top-elite, elite and non-elite youth female team handball players. J Sports Sci 33:1780–1789

    Article  PubMed  Google Scholar 

  36. Mukaka M (2012) Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 24:69–71

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Myklebust G, Engebretsen L, Brækken IH, Skjølberg A, Olsen O-E, Bahr R (2003) Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 13:71–78

    Article  PubMed  Google Scholar 

  38. Nässi A, Ferrauti A, Meyer T, Pfeiffer M, Kellmann M (2017) Development of two short measures for recovery and stress in sport. Eur J Sport Sci 17:894–903

    Article  PubMed  Google Scholar 

  39. Newcombe R (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872

    Article  CAS  PubMed  Google Scholar 

  40. Petersen W, Stöhr A, Ellermann A, Achtnich A, Müller PE, Stoffels T et al (2016) Return to sports after ACL reconstruction. Recommendations of the DKG ligament expert group. OUP 5:167–176

    Google Scholar 

  41. Petersen W, Zantop T, Steensen M, Hypa A, Wessolowski T, Hassenpflug J (2002) Prevention of lower extremity injuries in handball: initial results of the handball injuries prevention programme. Sportverletz Sportschaden 16:122–126

    Article  CAS  PubMed  Google Scholar 

  42. Pieper H-G, Muschol M (2007) Sports injuries and overuse syndromes in team handball. Sports Orthop Traumatol 23:4–10

    Article  Google Scholar 

  43. Póvoas SC, Ascensão AA, Magalhães J, Seabra AF, Krustrup P, Soares JM et al (2014) Physiological demands of elite team handball with special reference to playing position. J Strength Cond Res 28:430–442

    Article  PubMed  Google Scholar 

  44. Rameshkannan S, Chittibabu B (2014) Effect of plyometric training on agility performance of male handball players. IJPEFS 3:72–76

    Article  Google Scholar 

  45. Rühlemann A, Mayer C, Götte L, Behringer M, Jäger M (2019) Functional knee stability in handball: an indispensable criterion for safe sport. Sportverletz Sportschaden 33:87–95

    Article  PubMed  Google Scholar 

  46. Schwellnus M, Soligard T, Alonso J, Bahr R, Clarsen B, Dijkstra H et al (2016) How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. Br J Sports Med 50:1043–1052

    Article  PubMed  Google Scholar 

  47. Society for Arthroscopy and Joint Surgery A. Evaluation of the AGA instructor survey: “Post-treatment schemes after isolated reconstruction of the anterior cruciate ligament“. 2017. Accessed 19 Nov 2017

  48. Soligard T, Schwellnus M, Alonso J, Bahr R, Clarsen B, Dijkstra H et al (2016) How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med 50:1030–1041

    Article  PubMed  Google Scholar 

  49. Sonesson S, Kvist J, Ardern C, Österberg A, Silbernagel KG (2017) Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc 25:1375–1384

    Article  PubMed  Google Scholar 

  50. Yoon J, Yoon T, Shin B, Na E (2012) Factors affecting test results and standardized method in quiet standing balance evaluation. Ann Rehabil Med 36:112–118

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Funded by institutional resources (Chair/Faculty).

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstrasse 55, D-45147, Essen, Germany

    Alina Rühlemann, Constantin Mayer, Thomas Albrecht & Marcus Jäger

Authors
  1. Alina Rühlemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Constantin Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Albrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcus Jäger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors AR and MJ have concepted and designed the study. Acquisition of data was performed by AR and CM. Analysis and interpretation of data were done by AR, CM, TA, and MJ. AR and CM have been involved in drafting the manuscript. AR, CM, TA, and MJ have been involved in revising it critically for important intellectual content. AR, CM, TA, and MJ have given the final approval of the version to be published. AR, CM, TA, and MJ agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Marcus Jäger.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

The study was approved by the ethical committee of the University of Duisburg-Essen (#18-8078-BO).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rühlemann, A., Mayer, C., Albrecht, T. et al. Functional knee stability in non-elite handball: balance and jump performance differ based on players’ position. Knee Surg Sports Traumatol Arthrosc 28, 1212–1220 (2020). https://doi.org/10.1007/s00167-019-05693-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05693-y

Keywords

Search

Navigation